Classification of Head Injury
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Transcript Classification of Head Injury
Head Injury
1
Prehistorycal
types of
trepanation
2
3
Treatment of
depressed skull
fracture , XVI
century
Classification of Brain Injury,
Petit, 1774
4
Cerebral concussion (commotio cerebri)
Cerebral contusion (contusio cerebri)
Cerebral compression (compresio cerebri)
Causes of head injury in the USA
5
Fall from e
height
Trafic
accidents
Classification of
Head Injury
6
On pathology basis
7
focal
diffuse
depending on infection risk
Closed
Open
penetrating
not
8
penetrating
Clinical forms of head injury
Cerebral concussion
Brain contusion
Mild
moderate
severe
9
Diffuse axonal injury
Cerebral compression
Head compression
Pathogenesis of head injury
Initial lesions
contusion
diffuse axon injury
hemorrhages
injury of cranial
nerves
Secondary lesions
Intracranial
cerebral compression
with hematomas
Vioaltion of CSF and
blood circulation
Brain edema
Extracranial
Anemia
hypoxemia
hypertermia
10
Pathology of head injury
concussion Lesions on level of cellular organelle,
axons, synapses
mild
contusion
spot hemorrhages in cortex, local
subarachnoidal hemorage
moderate
contusion
Primary necrosis in cortex and white
substance, diffuse hemorages in 1-2
gyruses
Large necrosis and hemorages
Severe
contusion
11
Clinical presentations of head
injury
Signs of injury on the scalp (wounds, contusion)
Impaired consciousness
Amnesia
Focal neurological deficit
12
Pupil asymmetry
Cranial nerve deficit
Paresis
Reflex asymmetry and depression
Aphasia
Seizures
Level of consciousness
1.
2.
3.
4.
5.
6.
7.
13
Clear consciousness - full and adequate orientation and
reactions. Possible amnesia.
Mild– slight sleepiness, some time and place disorientantion,
some slowness in command obey,
– hypersomnia, disorientation, only elementary verbal contact is
possible, obeys only simplest verbal instructions.
Stupor – verbal contact is impossible, reactions and eye opening
on pain are preserved.
Mild coma – no eye opening, noncoordinated reactions on pain.
Pupil and corneal reflexes are preserved.
Severe coma – no response on pain, best motor response is
extension or flexion. Pupil and corneal reflexes are decreased.
Spontaneous respiration and blood circulation are preserved with
probable violations.
Terminal coma – no reflexes, muscle atonia, midriasis
Glasgow Coma Scale
Eye
opening
Best
verbal
respons
e
Best
motor
respons
e
Spontaneously
4 points
Opens eyes to voice
3 points
Opens eyes to pain
2 points
No eye opening
1 points
Spontaneous, appropriate and oriented
5 points
Confused conversation, phrases only
4 points
One word speech, inappropriate words
3 points
Incomprehensible sounds only
2 points
No sounds
1 points
Obeys commands
6 points
Localizes pain
5 points
Withdraws to pain
4 points
Abnormal flexor response (decoricated rigidity)
3 points
Abnormal extensor response (decerebrated rigidity) 2 points
14
No movements
1 points
Evaluation of consciousness after
Glasgow coma scale
Level of consciousness
Clear
Mild
Severe
Stupor
Mild coma
Severe coma
Terminal coma
15
Points in GCS
15
13-14
11-12
8-10
6-7
4-5
3
Severity of head injury
16
mild (13-15 point in Glasgow coma scale) –
cerebral concussion, slight cerebral
contusion
moderate (8-12 point) – mild cerebral
contusion, subacute and chronic cerebral
compression
severe (3-7 point) – severe cerebral
contusion, diffuse axon injury, acute cerebral
compression
17
mild
cerebral
contusion –
punctated
hemorages
18
mild
cerebral
contusion
19
mild cerebral contusion
20
contusion
21
Mild
cerebral
contusion
22
Mild
cerebral
contusion
(on MRI)
Two
contusion
focuses
1- direct blow
on the right
2-countercoup
on the left
23
24
Depressed skull fracture
25
Linear fracture of occipital bones with going to
the skull base
26
fracture of parietal and frontal bones
27
Depressed fracture of parietal bone
28
Severe
cerebral
contusion
29
Severe
cerebral
contusion
30
Severe
cerebral
contusion
31
Severe
cerebral
contusion
32
Depressed
fracture of
parietal and
temporal
bones
33
Diffuse axon
injury – there
are no
macroscopic
lesions
34
Axonal spheres at diffuse axon injury.
35
Поперечний зріз
аксона, норма
Після травми.
відсутні
мікротрубочки
36
Diffuse axon injury on CT (no lesions)
37
Head
compression
Cerebral compression
38
Acute – manifestation during 24 hours
after head injury
Subacute – manifestation during 1 week
after head injury
Chronic - manifestation after 1-2 weeks
after head injury
Causes of cerebral compression
Hematomas
39
Epidural
Subdural
Intracerebral
Bone fragment at depressed fructures
Pneumocephalus
Main triad at cerebral
compression
Deterioration of consciousness
level
Ipsilateral anisocoria
contrlateral hemiparesis
40
41
Epidural
hematoma
on the left
Subdural
hematoma
on the
right
42
Intracerebral
hematoma
43
Epidural
hematoma
on CT
44
Epidural
hematoma in
posterior fossa
45
Subdural
hematoma
46
Chronic bilateral subdural hematomas
47
Subacute hematoma
48
Localization of intracerebral hematomas
49
Intracerebral hematoma on MRI
50
Intracerebral
hematoma
51
Intracerebral
hematoma in
the frontal
lobe
52
Intracerebral hematoma
53
Combination of subdural and Intracerebral
hematomas
54
Acute traumatic
pneumocephalus
Treatment of moderate and
severe head injury
55
Acute resuscitation
Diagnostic procedures
Definitive treatment
Treatment
Acute resuscitation
ABC
Air pathway – cleaning of throat, airway tube, tracheal
tube
Breathing –
Circulation
56
Oxygen mask for stuporose and soporose patients
Intubation for comatose
Intravenous fluids for maintaining normal blood pressure
Maintaining adequate perfusion pressure of the brain
Treatment
Diagnostic procedures
Neurological examination
State of consciousness, GCS
Major neurological deficit
Pulse rate, blood pressure
Neurovisualization
57
Pupillary reflexes and symmetry
Ocular movement
Lower brain stem reflexes
Motor examination (hemiparesis, reflexes)
Plain X-ray examination
CT
Cerebral angiography
Diagnostic bur holes and ventriculography
MRI
Definitive treatment
Typical indications for surgery
58
Epidural and subdural hematomas that cause
depressed consciousness
Intracerebral hematoma and contusion in
comatose and soporose patients with
significant mass-effect on CT
Depressed skull fractures
Gunshot wounds
Insertion of Intacranial pressure monitor
Periods of head injury
59
Acute – 2-4 weeks
Intermediate – 2-6 weeks
Remote
60
bur hole
61
Approach to fronto-temporal and parietotemporal lobes
62
Approach
to frontal
lobe
63
Approach
to
temporal
lobe
64
Approach
to parietal
lobe
65
Approach to
occipital
lobe
66
Posterior
fossa
approach
67
Removal of epidural hematoma
68
Dendy’s
point for
puncture of
posterior
horn of
lateral
ventricle
69
Kocher’s
point for
punction of
anterior horn
of lateral
ventricle